Provider Demographics
NPI:1700852316
Name:DAVID, DANIEL ALFRED I
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:ALFRED
Last Name:DAVID
Suffix:I
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5601 FIELD STREAM DR
Mailing Address - Street 2:
Mailing Address - City:EXPORT
Mailing Address - State:PA
Mailing Address - Zip Code:15632-9222
Mailing Address - Country:US
Mailing Address - Phone:724-325-8405
Mailing Address - Fax:
Practice Address - Street 1:135 E MARKET ST
Practice Address - Street 2:
Practice Address - City:BLAIRSVILLE
Practice Address - State:PA
Practice Address - Zip Code:15717-1369
Practice Address - Country:US
Practice Address - Phone:724-459-7400
Practice Address - Fax:724-459-8207
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP028416L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0178510001Medicare ID - Type Unspecified